FirstCare's Special Investigations Unit (SIU)

By clicking the above link I acknowledge that I have read and understand the following advisory:Please be advised, any information provided in the FirstCare Incident Report Form will become part of an investigation which may be shared with federal or state government agencies. Generally, information received by FirstCare's Special Investigations Unit is considered confidential and will not be disclosed unless otherwise required by law.

Join forces with FirstCare's SIU to investigate health care fraud and compliance incidents perpetrated by either a FirstCare member, FirstCare provider, and /or other party.

Know that FirstCare will work jointly with various state and federal agencies to prosecute health care FWA, including the Federal Bureau of Investigation (FBI), Internal Revenue Service (IRS), United States Health and Human Services Division - Office of Inspector General (OIG), Texas Attorney General's Office, Texas Health and Human Services Commission - Office of Inspector General, and local law enforcement authorities.

Information given on this FirstCare Incident Report Form will become part of an investigation which may be shared with federal or state government agencies. Generally, information received by FirstCare's Special Investigations Unit will be kept confidential unless required by law.

What is Fraud, Waste and Abuse?

Fraud is any intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to that person or some other person. The term does not include unintentional technical, clerical, or administrative errors.

Waste involves practices that a reasonably prudent person would deem careless or that would allow inefficient use of resources, items, or services.

Abuse involves practices that are inconsistent with sound fiscal or business practices and that result in unnecessary costs.

Provider Fraud, Waste and AbusePlease tell usif you suspect a provider of the following:

Billing for services or items that were never provided

Billing separate claims for services that should be billed together as a single item

Billing for services or equipment that are more expensive than what was supplied

Continuing to bill for home medical equipment after it has been returned

Taking payment from another provider in exchange for referring a patient

Allowing an unlicensed person to perform treatment and billing as if a qualified individual had performed the service.

Recipient Fraud, Waste and AbuseIndividuals may try to game the system to receive money and/or benefits they don't deserve. It is a crime to commit insurance fraud, and people can lose their benefits and be prosecuted.

To help prevent FWA, reportyour suspicions. Review your Explanation of Benefits or payment notice for errors. Make sure you were not billed for health care services, medical supplies or equipment you did not receive.